February 18, 2021

Background:  Headache was the 5th most common reason for patients to present to the emergency department in the US in 2016.  Often ED providers include IV fluid boluses in their headache treatment cocktail, with prior research demonstrating IV fluids are included approximately 40% of the time (Jones).  While dehydration may precipitate some headaches, there is little evidence to support the use of IV fluids for their treatment.

December 7, 2020

Background: SARS-CoV-2 infection has resulted in a high mortality rate, with the majority of deaths resulting from respiratory failure. As waves of the pandemic continue to overwhelm healthcare systems throughout the world, a pragmatic risk stratification tool that would allow for the early identification of patients with COVID-19 infection who are at the highest risk of death could help guide the management of individual patients as well as resource utilization.  In a systematic review from April 2020, Wynants et al found that prediction models have rapidly entered the literature since the start of the covid-19 pandemic, but that they are of questionable quality and at high risk of bias, and as such are not ready for general use.  A prediction model based on a large cohort with high quality methods would be of great value to the medical community.  

October 22, 2020

Background: Acute gastroenteritis (AGE) is a very common emergency department (ED) presentation, with “approximately 1.5 million pediatric outpatient visits and 200,000 admissions” each year (Benary).   Treatment for AGE is mainly supportive, utilizing rehydration therapy and antiemetic medications.  One common and well studied antiemetic is ondansetron, which has been shown to be effective at controlling vomiting and decreasing hospitalization rates in pediatric patients.  Despite its widespread use within the emergency department, there is significant variation in the use of ondansetron as a discharge prescription, with providers noting the fear of masking a worsening condition or missed diagnosis and thus preventing a necessary return visit.  

September 28, 2020

Background: FOOSH injuries, or falls onto outstretched hands, are a common presentation to the emergency department, and can frequently result in scaphoid fractures.  In fact, scaphoid fractures “account for 90% of all carpal fractures and 2-7% of all fractures” (Dias).  The most common location for a scaphoid fracture is within the scaphoid waist.  As with any fracture, in treating a scaphoid fracture, the goal is to stabilize fracture fragments in alignment to allow healing.  For scaphoid fractures, this can be accomplished with either casting to immobilize the wrist or by placing a screw through the fracture.  Traditional treatment strategy usually included plaster cast immobilization for 6-10 weeks, with operative fixation only for the roughly 10% of cases in which healing was unsatisfactory.  In recent years, however, there has been a trend toward early surgical intervention.  This trend results in higher costs and more invasive procedures, but is thought to speed recovery, allowing for earlier return to normal function.  In 2018, a systematic review and meta-analysis (14 trials with 765 patients) by Li et al compared surgical vs. non-surgical treatment of scaphoid waist fractures showed “no statistical difference in patient satisfaction, pain, and The Disability of the Arm, Shoulder, and Hand scores between surgical treatment and nonsurgical treatment.” Due to the variable quality of the data analyzed, the authors recommended further high-quality studies (Li).  

March 9, 2020

Background: Oxygen therapy is frequently used in the emergency department for the treatment of hypoxia and respiratory failure and can be delivered in a variety of ways. Conventional oxygen therapy (COT) via nasal cannula is often a first line treatment, but has some drawbacks, including inability to deliver a precise concentration and volume of oxygen, inability to deliver high enough concentration and volume of oxygen, inability to heat and humidify, and poor tolerance.  While it is able to deliver more precise, high flow oxygen, noninvasive ventilation (NIV) also presents a comfort challenge for many patients. High flow nasal cannula (HFNC) has been introduced as an alternative to COT and NIV. It can be used to deliver heated, humidified oxygen at high rates (up to 60 L/min) and maintain a set oxygen fraction. Prior randomized controlled trials (RCTs) and meta-analysis comparing HFNC to COT and NIV have demonstrated conflicting results. Additionally, none of these previous meta-analyses have evaluated emergency department (ED) patients.